Study Questions:

What is the association between hospital transcatheter aortic valve replacement (TAVR) volume and 30-day readmission?

Methods:

This was an observational study using the 2014 Nationwide Readmissions Database to identify hospitals with established TAVR programs (performing at least five TAVRs in the first quarter of 2014). Based on annual TAVR volume, hospitals were classified as low (<50), medium (≥50 to <100), and high (≥100) volume. Rates, causes, and costs of 30-day readmissions were compared between low-, medium-, and high-volume hospitals. Data were analyzed from November to December 2016. The main outcome measure was 30-day readmissions.

Conclusions:

The authors concluded that there is an inverse association between hospital TAVR volume and 30-day readmissions.

Perspective:

This observational study reports an inverse association between hospital TAVR volume and 30-day readmission rates, with noncardiac readmissions being more common in low-volume hospitals, whereas cardiac readmissions were more common in high-volume hospitals. Although the cost of all readmissions was similar, lower readmission rates at high-volume hospitals equate to lower health care costs and substantial savings. These data may help guide policy makers in the future to identify targets for optimizing and standardizing TAVR outcomes across hospitals with different volumes. Current strategy should be to use best practices and have TAVR programs analyze their outcomes, compare them with national benchmarks, and take actions that are likely to improve their hard outcomes as well as reduce readmissions.